Dosage & Route

Initial: 6.25 mg/day, may increase after several wk to 150 mg/day in divided doses if needed and tolerated.

Diabetic nephropathy 25 mg 3 times/day.

Therapeutic actions

Captopril competitively inhibits the conversion of angiotensin I (ATI) to angiotensin II (ATII), thus resulting in reduced ATII levels and aldosterone secretion. It also increases plasma renin activity and bradykinin levels. Reduction of ATII leads to decreased sodium and water retention. By these mechanisms, captopril produces a hypotensive effect and a beneficial effect in congestive heart failure.

Pharmacokinetics

Absorption: 60-75% absorbed from the GI tract (oral); peak plasma concentrations after 1 hr. Absorption may be reduced in the presence of food.

Interventions

Administer 1 hr before meals.

[box type=”note”]WARNING: Ensure that patient is not pregnant before beginning treatment. Encourage use of contraceptives; if pregnancy is detected, stop drug.[/box]
[box type=”note”]WARNING: Alert surgeon and mark patient’s chart with notice that captopril is being taken; the angiotensin II formation subsequent to compensatory renin release during surgery will be blocked; hypotension may be reversed with volume expansion.[/box]

Monitor patient closely for fall in BP secondary to reduction in fluid volume (due to excessive perspiration, and dehydration, vomiting, or diarrhea); excessive hypotension may occur.

Reduce dosage in patients with impaired renal function.

Teaching points

Take drug 1 hour before meals; do not take with food. Do not stop without consulting your healthcare provider.

Be careful of drop in blood pressure (occurs most often with diarrhea, sweating, vomiting, or dehydration); if lightheadedness or dizziness occurs, consult your healthcare provider.

Severe fetal damage can occur if captopril is taken during pregnancy. Use of contraceptives is advised; if pregnancy should occur, stop drug and notify health care provider.

You may experience these side effects: Cough, GI upset, loss of appetite, change in taste perception (limited effects, will pass); mouth sores (frequent mouth care may help); rash; fast heart rate; dizziness, light-headedness (usually passes after the first few days; change position slowly, and limit your activities to those that do not require alertness and precision).

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